How to get the most out of one’s Medicare Advantage Plan

Presented by South Bay Health & Insurance Services

Medicare Advantage is one of the options available to Medicare recipients. It combines Medicare Parts A, B and often D coverage and is offered by private insurance companies. Medicare Advantage Plans must provide all of the services covered by Original Medicare, but usually at a lower cost.

Each plan can charge different co-payments and have rules for obtaining services (like whether one needs a referral to see a specialist or has to go to a network only doctor for non-emergency care). To be eligible for that kind of plan, one must have Medicare Parts A and B, live in the plan’s service area and cannot have End-Stage Renal Disease (permanent kidney failure).

Most plans in San Diego County have no additional monthly premium and include prescription drug coverage (Part D). Medicare Advantage plans offer a variety of preventive tests and checkups with no co-payment, as well as additional benefits such as vision, dental, fitness club membership, transportation and discounts for product and services.

The primary care physician and his medical group are the most important elements of a Medicare Advantage plan. It is important for the individual to do research in choosing the right one.

If one’s medical condition is complex, a doctor of internal medicine or a general practitioner with a specialty in Geriatrics might be a better choice. It is important to make sure that the doctor selected is a good communicator, treating patient as partners and willing to work with other specialists. If a patient is enrolled in a Medicare Advantage plan, the doctor needs to approve that choice. Medicare Advantage plans are an excellent choice for patients, but may require more involvement from a doctor. To get the most from a Medicare Advantage plan, it is important that the patient chooses a physician who is willing to go that extra mile.

Selecting the right medical group will also impact the patient’s Medicare Advantage experience. The network of specialists, hospital affiliation, way and speed with which referrals are handled as well as additional services vary from one group to another. Many primary care physicians are affiliated with more than one group.

After choosing a new primary care physician while enrolled in a Medicare Advantage plan, a patient should schedule their first “get accounted” appointment as soon as possible. Establishing oneself as a patient and making a connection with their doctor early on is very important.

If a patient has chosen to keep their existing doctor, the physician should be contacted as soon as the Medicare Advantage plan becomes effective to obtain referrals for previously scheduled specialist appointments and to get new prescriptions for needed medications. A patient should contact their medical group to find out what services are offered through their health plan.

For more information about South Bay Health Insurance & Services, call (800) 988-5047.